高原低氧环境与男性生精功能适应性改变  

High Altitude Hypoxic Environment and Adaptive Changes of Male Spermatogenic Function

作　　者：顾本宏 胡剑麟 李君 欧珠罗布 刘晓强[5] GU Benhong;HU Jianlin;LI Jun;Ouzhu-LuoBu;LIU Xiaoqiang(Department of Urology,Tong Ren Hospital,Shanghai Jiaotong University School of medicine,Shanghai 200336,China;Department of Andrology,andrology clinical medical center,Shanghai General Hospital Shanghai Jiao Tong University,Shanghai 200080,China;Reproductive medicine center,FuKang Maternity and Children’s Hospital,Lhasa 850000,China;School of Medicine,Tibet University,Lhasa 850000,China;Tianjin Medical University General Hospital,Tianjin 300052,China)

机构地区：[1]上海交通大学医学院附属同仁医院泌尿外科,上海200336 [2]上海交通大学附属第一人民医院男性健康评估中心,上海200080 [3]西藏阜康医院妇产儿童院区生殖医学中心,西藏拉萨850004 [4].西藏大学高原医学中心,西藏拉萨850000 [5]天津医科大学总医院,天津300052

出　　处：《高原科学研究》2021年第1期66-75,共10页Plateau Science Research

基　　金：国家自然科学基金项目(31660308);上海市科委研究项目(17JC14200403);赵以成医学科学基金(ZYYFY2018031)。

摘　　要：目的:探讨移居高原汉族、世居高原藏族和平原汉族男性精液参数特征,分析高原低氧环境对男性生精功能的影响。方法:从不育门诊收集非无精子症男性3 872例,其中移居汉族1 126例,世居藏族1 094例,平原汉族1 652例;行精液常规、精子形态学、精子运动轨迹分析,并分别对686 606例男性行精子DNA完整性检测与生殖内分泌激素测定,分别比较移居汉族、世居藏族及平原汉族男性生育力及生殖内分泌激素变化特征。结果:移居汉族男性较世居藏族和平原汉族男性精子总数(202.16×106/mL vs.144.81×106/mL vs. 139.10×106/mL)、精子活率(59.25%vs. 55.26%vs. 43.88%)和DFI (23.56%vs. 22.59%vs.6.57%)升高,差异有极显著统计学意义(P<0.001);但前向运动精子百分率(34.98%vs. 32.70%vs.29.82%)、正常形态精子百分率(3.91%, 3.83%vs. 7.18%)、VCL平均值(47.62μm/s vs. 37.02μm/s vs.35.45μm/s)、VS.L平均值(14.72μm/s vs. 14.22μm/s vs. 30.76μm/s)等方面相互比较,则平原汉族>移居汉族>世居藏族,差异有极显著统计学意义(P<0.001)。平原汉族男性雌激素(E2)、睾酮(T)、Prog(孕激素)水平大于移居汉族和世居藏族,黄体生成素(LH)、泌乳素(PRL)则小于世居藏族和移居汉族,差异有极显著统计学意义(P<0.001)。结论:长期高原低氧环境使男性生殖内分泌激素及生精功能发生适应性改变,表现为雄激素水平、正常形态精子百分比和前向运动精子百分比下降,DFI增高,但这并不影响男性生殖能力,也不影响高原人口快速增长趋势。Objective To investigate the characteristics of semen parameters of high altitude immigrated Han Chinese(IHC) men who migrated to high altitude,native Tibetan who lived in high altitude and plain lived Han Chinese(PLHC) men,and to analyze the influence of high altitude hypoxic environment on male spermatogenesis.Methods 3 872 male patients with non-azoospermia were collected from the infertility clinic,including 1 126 IHC,1 094 native Tibetans and 1 652 PLHC.The conventional semen parameters,sperm morphology and sperm movement track were analyzed.The sperm DNA fragmentation index(DFI) and reproductive endocrine hormones were detected in 686 and 606 males,respectively.The changes of male fertility and reproductive endocrine hormones were compared among IHC,native Tibetans and PLHC.Results The total sperm count(202.16×106/mL vs.144.81×106/mL vs.139.10×106/mL),sperm motility(59.25% vs.55.26% vs.43.88%) and DFI(23.56% vs.22.59% vs.6.57%) were significantly higher in IHC than those in native Tibetan men and PLHC(P<0.001).However,the percentage of sperm progressive motility(34.98% vs.32.70% vs.29.82%) and sperm normal forms(3.91% vs.3.83% vs.7.18%),average value of VCL(47.62 μm/s vs.37.02 μm/s vs.35.45 μm/s) and VS.L(14.72 μm/s vs.14.22 μm/s vs.30.76 μm/s) were significantly higher in PLHC than that of IHC,and IHC higher than native Tibetans(P<0.001).The levels of estrogen(E2),testosterone(T) and Prog(progesterone) in PLHC were higher than those in IHC and native Tibetans,while the levels of luteinizing hormone(LH) and prolactin(PRL) in PLHC were lower than that of IHC and native Tibetans(P<0.001).Conclusions The results showed that long-term living in hypoxic environment at high altitude cause adaptive changes in male reproductive endocrine hormone and spermatogenesis,The results showed that androgen level,percentage of normal morphology sperm and percentage of forward motile sperm decreased and DFI increased,but these factors did not affect the male reproductive capacity and the rapid growth of high altitude

关 键 词：高原 低氧 精子 DFI 生育力 性激素 

分 类 号：R188[医药卫生—流行病学]